The partnership principle: Together we are stronger

A message to all AMA members from the chair of the AMA Board of Trustees, Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted Sept. 4, 2006.

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I continue to be struck by the power and success of partnerships within the House of Medicine, the multiplier effect that partnerships generate when each partner, acting in concert with others, becomes more influential and effective, and the whole becomes greater than the sum of its parts.

One person who is acting alone might be effective. That same person working in partnership with others leverages individual influence and effectiveness enormously.

Benjamin Franklin saw an almost spiritual aspect to partnership when he wrote, "All who think cannot but see there is a sanction like that of religion which binds us in partnership in the serious work of the world."

A classic example is the American Medical Association's Physician Consortium for Performance Improvement. It is a partnership of groups working in common cause in response to a growing need for measures of performance, for standards of excellence. Serious work indeed.

The AMA convened the consortium in 2000, provides staffing and has invested millions of dollars in this effort. Membership includes more than 90 national medical specialty and state medical societies, as well as the U.S. Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services and a number of Quality Improvement Organizations.

The consortium will have developed approximately 150 measures by the end of 2006. This will give physicians the needed tools to continue to advance quality of care for patients.

Because these measures are produced by physicians based on the best of scientific evidence, we expect that they will become the standard for physicians and others to use in evaluating and reporting the quality of medical care.

You can see for yourself the power of this partnership on the AMA Web site (link).

The opposite of partnership is unproductive competition, as seen in many parts of our U.S. health care system.

Two eminent scholars, Michael Porter of the Harvard Business School and Elizabeth Olmsted Teisberg of the University of Virginia's Darden Graduate School of Business, have examined the U.S. health care system and found it wanting.

In their landmark book, Redefining Health Care, they ask why competition isn't working in the health care industry the way it works in other industries, increasing customer value and lowering cost.

Why have decades of reform made matters only worse? What needs to be done to right the ship?

In their careful analysis, they point out that too much of our professional lives is spent in needless conflict, a "zero-sum game" of I win and you lose.

The consequences of that approach pit physician against physician, hospital against hospital, insurer against insurer and all against all, a Hobbesian nightmare that works, ultimately, to the detriment of our patients, the taxpayers and premium payers, the voters and buyers of health care services.

I find a ray of hope in one aspect of the Porter and Teisberg analysis. Their call for a "value revolution" pivots on a rediscovery of the value of partnership.

The voluntary cooperation that undergirds our Association is evident in every action and reaction within the House of Delegates. Far from setting aside our differences, we bring them to the table, shine the bright light of public analysis on them and decide our future course of action.

Open discussion, frank communication, is an absolute necessity to a successful partnership. Sam Walton, founder of Wal-Mart, once wrote: "Communicate everything you possibly can to your partners. The more they know, the more they'll understand. The more they understand, the more they'll care. Once they care, there's no stopping them.

"If you don't trust your associates to know what's going on, they'll know that you don't really consider them partners."

Beyond the tasks at hand, partnerships create trust and loyalty, goodwill and high morale.

As we work together to reform the U.S. health care system, to put things back on track, the partnership principle will continue to be important to us all.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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